Thank you for your question. Breast implant upper pole malposition at 6 months after surgery can have various causes, and identifying the specific reason is crucial for effective management. As a plastic surgeon who specializes in breast revision surgery at Blue Ocean Plastic Surgery, I will highlight a few common factors that can contribute to this issue based on widely-accepted, published principles of breast surgery. Inadequate implant pocket creation: Improper placement of the implant pocket during surgery can result in malposition. This may include subglandular placement without adequate support from the pectoralis muscle or inadequate release of the inframammary fold. This can lead to the implant sitting too high on the chest. Based on your photos, it appears as though the right inframammary fold was not released adequately. The shape of each breast is different. Capsular contracture: Capsular contracture is the excessive scar tissue formation around the implant. It can cause the implant to be displaced upwards, resulting in upper pole malposition. Capsular contracture can be influenced by various factors, such as inflammation, infection, or implant texture. Weak or stretched lower pole tissues: In some cases, the natural breast tissues may be weak or have poor elasticity, leading to inadequate support of the implant in the lower pole. Over time, the implant may shift upwards, causing upper pole malposition. Implant size and weight: Larger and heavier implants may exert more pressure on the lower pole tissues, potentially contributing to upper pole malposition over time. Surgical technique: Surgeon experience, technique, and precision play a significant role in preventing malposition. Careful dissection, appropriate pocket creation, and accurate implant placement are crucial for achieving optimal results. It appears from your photo that the upper, medial pole of the right pectorals may have been excessively released, distorting the cleavage and causing the breast to be misshapen. The left breast lacks a natural lower pole curve, possibly because of implant placement or choice.It is important to note that each case is unique, and a thorough evaluation by a board-certified plastic surgeon is necessary to determine the exact cause and develop an appropriate treatment plan. Surgical correction may be required to reposition the implant and restore a balanced breast appearance.